Resp Care
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The need for delivery resuscitation of the newborn cannot be predicted in most cases; therefore it is judicious to train all providers who may be involved in the delivery of newborns to follow guidelines developed to improve outcome, especially in the presence of transitional asphyxia. The Neonatal Resuscitation Program emphasizes basic steps of warming, drying, suctioning, and adequately ventilating the newborn. It also addresses current theories regarding resuscitation of the low birthweight newborns, infants with meconium aspiration, and medication use. ⋯ The Pediatric Advanced Life Support course focuses on early recognition and treatment of respiratory failure and shock. The possibility of improving outcome with properly trained prehospital providers is a topic of interest. Intubation in the field can be successful and may contribute to a reduction in mortality, although complications of field intubation need to be reduced.
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The development of the AHA Guidelines for CPR and ECC and the AARC RACH Clinical Practice Guideline should both be instrumental in improving the performance of RCPs on in-hospital resuscitation teams. The AARC and AHA are assuming important leadership roles in this movement by publishing CPGs for CPR and ECC. RCPs with ACLS training are in a prime position to assume more responsibility on resuscitation teams within acute care facilities. ⋯ Successful CPR outcome should be carefully defined using the patient's disease category. Each patient should be individually evaluated for DNR orders. As suggested by Schwenzer, "Patients' perception of their quality of life before and after CPR should guide their and our decisions." However, we must all accept the responsibility for defining the limitations of medical technology and try to determine when CPR is futile.